|
MENEST 0.625MG TABLET
|
Facility
|
OP
|
$10.66
|
|
|
Service Code
|
NDC 61570007301
|
| Hospital Charge Code |
25000960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$10.23 |
| Rate for Payer: Aetna Commercial |
$8.21
|
| Rate for Payer: Anthem Medicaid |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.31
|
| Rate for Payer: Cash Price |
$5.33
|
| Rate for Payer: Cigna Commercial |
$8.85
|
| Rate for Payer: First Health Commercial |
$10.13
|
| Rate for Payer: Humana Commercial |
$9.06
|
| Rate for Payer: Humana KY Medicaid |
$3.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.38
|
| Rate for Payer: Ohio Health Group HMO |
$8.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.30
|
| Rate for Payer: PHCS Commercial |
$10.23
|
| Rate for Payer: United Healthcare All Payer |
$9.38
|
|
|
MENIGOCOCCAL POLYSACC VAC .5ML
|
Professional
|
Both
|
$548.00
|
|
|
Service Code
|
HCPCS 90733
|
| Hospital Charge Code |
77000047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.24 |
| Max. Negotiated Rate |
$548.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$548.00
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Healthspan PPO |
$116.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$195.20
|
| Rate for Payer: Multiplan PHCS |
$328.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$383.60
|
| Rate for Payer: UHCCP Medicaid |
$191.80
|
|
|
MENIGOCOCCAL POLYSACC VAC .5ML
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
HCPCS 90733
|
| Hospital Charge Code |
770T0047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem Medicaid |
$188.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Humana KY Medicaid |
$188.46
|
| Rate for Payer: Kentucky WC Medicaid |
$190.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.88
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
MENIGOCOCCAL POLYSACC VAC .5ML
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
HCPCS 90733
|
| Hospital Charge Code |
77000047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem Medicaid |
$188.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Humana KY Medicaid |
$188.46
|
| Rate for Payer: Kentucky WC Medicaid |
$190.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.88
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
MENIGOCOCCAL POLYSACC VAC .5ML
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
HCPCS 90733
|
| Hospital Charge Code |
770T0047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.88
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
MENIGOCOCCAL POLYSACC VAC .5ML
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
HCPCS 90733
|
| Hospital Charge Code |
77000047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.88
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
MENISCAL CINCH CVD TIP
|
Facility
|
OP
|
$3,197.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.68 |
| Max. Negotiated Rate |
$3,069.60 |
| Rate for Payer: Aetna Commercial |
$2,462.08
|
| Rate for Payer: Anthem Medicaid |
$1,099.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,494.05
|
| Rate for Payer: Cash Price |
$1,598.75
|
| Rate for Payer: Cigna Commercial |
$2,653.92
|
| Rate for Payer: First Health Commercial |
$3,037.62
|
| Rate for Payer: Humana Commercial |
$2,717.88
|
| Rate for Payer: Humana KY Medicaid |
$1,099.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,110.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,621.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,359.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,121.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,813.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$639.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$991.22
|
| Rate for Payer: PHCS Commercial |
$3,069.60
|
| Rate for Payer: United Healthcare All Payer |
$2,813.80
|
|
|
MENISCAL CINCH CVD TIP
|
Facility
|
IP
|
$3,197.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.68 |
| Max. Negotiated Rate |
$3,069.60 |
| Rate for Payer: Aetna Commercial |
$2,462.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,494.05
|
| Rate for Payer: Cash Price |
$1,598.75
|
| Rate for Payer: Cigna Commercial |
$2,653.92
|
| Rate for Payer: First Health Commercial |
$3,037.62
|
| Rate for Payer: Humana Commercial |
$2,717.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,621.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,359.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,813.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$639.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$991.22
|
| Rate for Payer: PHCS Commercial |
$3,069.60
|
| Rate for Payer: United Healthcare All Payer |
$2,813.80
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$11,644.40
|
|
|
Service Code
|
MSDRG 760
|
| Min. Negotiated Rate |
$7,901.56 |
| Max. Negotiated Rate |
$11,644.40 |
| Rate for Payer: Anthem Medicaid |
$7,901.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,317.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,644.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,228.53
|
| Rate for Payer: Humana KY Medicaid |
$7,901.56
|
| Rate for Payer: Humana Medicare Advantage |
$8,317.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,980.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,980.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,059.59
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$7,084.43
|
|
|
Service Code
|
MSDRG 761
|
| Min. Negotiated Rate |
$4,807.29 |
| Max. Negotiated Rate |
$7,084.43 |
| Rate for Payer: Anthem Medicaid |
$4,807.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,060.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,084.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,831.42
|
| Rate for Payer: Humana KY Medicaid |
$4,807.29
|
| Rate for Payer: Humana Medicare Advantage |
$5,060.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,855.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,072.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,903.44
|
|
|
MENVEO VAC 0.5 ML INJECTION
|
Facility
|
OP
|
$584.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
25004043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$561.22 |
| Rate for Payer: Aetna Commercial |
$450.14
|
| Rate for Payer: Anthem Medicaid |
$201.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.99
|
| Rate for Payer: Cash Price |
$292.30
|
| Rate for Payer: Cigna Commercial |
$485.22
|
| Rate for Payer: First Health Commercial |
$555.37
|
| Rate for Payer: Humana Commercial |
$496.91
|
| Rate for Payer: Humana KY Medicaid |
$201.04
|
| Rate for Payer: Kentucky WC Medicaid |
$203.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$205.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.45
|
| Rate for Payer: Ohio Health Group HMO |
$438.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.23
|
| Rate for Payer: PHCS Commercial |
$561.22
|
| Rate for Payer: United Healthcare All Payer |
$514.45
|
|
|
MENVEO VAC 0.5 ML INJECTION
|
Facility
|
IP
|
$584.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
25004043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$561.22 |
| Rate for Payer: Aetna Commercial |
$450.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.99
|
| Rate for Payer: Cash Price |
$292.30
|
| Rate for Payer: Cigna Commercial |
$485.22
|
| Rate for Payer: First Health Commercial |
$555.37
|
| Rate for Payer: Humana Commercial |
$496.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.45
|
| Rate for Payer: Ohio Health Group HMO |
$438.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.23
|
| Rate for Payer: PHCS Commercial |
$561.22
|
| Rate for Payer: United Healthcare All Payer |
$514.45
|
|
|
MEPHYTON (PHYTONADION 5MG/1TAB
|
Facility
|
IP
|
$66.13
|
|
|
Service Code
|
NDC 70710101403
|
| Hospital Charge Code |
25000961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Aetna Commercial |
$50.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.58
|
| Rate for Payer: Cash Price |
$33.06
|
| Rate for Payer: Cigna Commercial |
$54.89
|
| Rate for Payer: First Health Commercial |
$62.82
|
| Rate for Payer: Humana Commercial |
$56.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.19
|
| Rate for Payer: Ohio Health Group HMO |
$49.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.50
|
| Rate for Payer: PHCS Commercial |
$63.48
|
| Rate for Payer: United Healthcare All Payer |
$58.19
|
|
|
MEPHYTON (PHYTONADION 5MG/1TAB
|
Facility
|
OP
|
$66.13
|
|
|
Service Code
|
NDC 70710101403
|
| Hospital Charge Code |
25000961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Anthem Medicaid |
$22.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.58
|
| Rate for Payer: Cash Price |
$33.06
|
| Rate for Payer: Cigna Commercial |
$54.89
|
| Rate for Payer: First Health Commercial |
$62.82
|
| Rate for Payer: Humana Commercial |
$56.21
|
| Rate for Payer: Humana KY Medicaid |
$22.74
|
| Rate for Payer: Kentucky WC Medicaid |
$22.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.19
|
| Rate for Payer: Ohio Health Group HMO |
$49.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.50
|
| Rate for Payer: PHCS Commercial |
$63.48
|
| Rate for Payer: United Healthcare All Payer |
$58.19
|
| Rate for Payer: Aetna Commercial |
$50.92
|
|
|
MEPRON(ATOVAQUON)750MG/5MLSUSP
|
Facility
|
OP
|
$73.86
|
|
|
Service Code
|
NDC 173066518
|
| Hospital Charge Code |
25000962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$70.91 |
| Rate for Payer: Aetna Commercial |
$56.87
|
| Rate for Payer: Anthem Medicaid |
$25.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.61
|
| Rate for Payer: Cash Price |
$36.93
|
| Rate for Payer: Cigna Commercial |
$61.30
|
| Rate for Payer: First Health Commercial |
$70.17
|
| Rate for Payer: Humana Commercial |
$62.78
|
| Rate for Payer: Humana KY Medicaid |
$25.40
|
| Rate for Payer: Kentucky WC Medicaid |
$25.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.00
|
| Rate for Payer: Ohio Health Group HMO |
$55.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.90
|
| Rate for Payer: PHCS Commercial |
$70.91
|
| Rate for Payer: United Healthcare All Payer |
$65.00
|
|
|
MEPRON(ATOVAQUON)750MG/5MLSUSP
|
Facility
|
IP
|
$73.86
|
|
|
Service Code
|
NDC 173066518
|
| Hospital Charge Code |
25000962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$70.91 |
| Rate for Payer: Aetna Commercial |
$56.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.61
|
| Rate for Payer: Cash Price |
$36.93
|
| Rate for Payer: Cigna Commercial |
$61.30
|
| Rate for Payer: First Health Commercial |
$70.17
|
| Rate for Payer: Humana Commercial |
$62.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.00
|
| Rate for Payer: Ohio Health Group HMO |
$55.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.90
|
| Rate for Payer: PHCS Commercial |
$70.91
|
| Rate for Payer: United Healthcare All Payer |
$65.00
|
|
|
MERREM 100MG(GEN) 1G V
|
Facility
|
IP
|
$112.90
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
25002228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$108.38 |
| Rate for Payer: Aetna Commercial |
$86.93
|
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$56.45
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$93.71
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: First Health Commercial |
$107.26
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Humana Commercial |
$95.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$84.68
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.00
|
| Rate for Payer: PHCS Commercial |
$108.38
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$99.35
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
MERREM 100MG(GEN) 1G V
|
Facility
|
OP
|
$112.90
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
25002228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$108.38 |
| Rate for Payer: Aetna Commercial |
$86.93
|
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem Medicaid |
$38.83
|
| Rate for Payer: Anthem Medicaid |
$40.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$56.45
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: Cigna Commercial |
$93.71
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: First Health Commercial |
$107.26
|
| Rate for Payer: Humana Commercial |
$95.96
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Humana KY Medicaid |
$38.83
|
| Rate for Payer: Humana KY Medicaid |
$40.58
|
| Rate for Payer: Kentucky WC Medicaid |
$40.99
|
| Rate for Payer: Kentucky WC Medicaid |
$39.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$84.68
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.58
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: PHCS Commercial |
$108.38
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
| Rate for Payer: United Healthcare All Payer |
$99.35
|
|
|
MERREM 100MG(GEN) 500MG V
|
Facility
|
IP
|
$16.35
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
25002227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$15.70 |
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.75
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cigna Commercial |
$13.57
|
| Rate for Payer: First Health Commercial |
$15.53
|
| Rate for Payer: Humana Commercial |
$13.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14.39
|
| Rate for Payer: Ohio Health Group HMO |
$12.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.07
|
| Rate for Payer: PHCS Commercial |
$15.70
|
| Rate for Payer: United Healthcare All Payer |
$14.39
|
|
|
MERREM 100MG(GEN) 500MG V
|
Facility
|
OP
|
$16.35
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
25002227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$15.70 |
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Anthem Medicaid |
$5.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.75
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cigna Commercial |
$13.57
|
| Rate for Payer: First Health Commercial |
$15.53
|
| Rate for Payer: Humana Commercial |
$13.90
|
| Rate for Payer: Humana KY Medicaid |
$5.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$14.39
|
| Rate for Payer: Ohio Health Group HMO |
$12.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.07
|
| Rate for Payer: PHCS Commercial |
$15.70
|
| Rate for Payer: United Healthcare All Payer |
$14.39
|
|
|
MESH 3D MAX 4*6 LRG L
|
Facility
|
IP
|
$1,981.05
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.54 |
| Max. Negotiated Rate |
$1,901.81 |
| Rate for Payer: Aetna Commercial |
$1,525.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,545.22
|
| Rate for Payer: Cash Price |
$990.52
|
| Rate for Payer: Cigna Commercial |
$1,644.27
|
| Rate for Payer: First Health Commercial |
$1,882.00
|
| Rate for Payer: Humana Commercial |
$1,683.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,624.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,462.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,743.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.13
|
| Rate for Payer: PHCS Commercial |
$1,901.81
|
| Rate for Payer: United Healthcare All Payer |
$1,743.32
|
|
|
MESH 3D MAX 4*6 LRG L
|
Facility
|
OP
|
$1,981.05
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.54 |
| Max. Negotiated Rate |
$1,901.81 |
| Rate for Payer: Aetna Commercial |
$1,525.41
|
| Rate for Payer: Anthem Medicaid |
$681.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,545.22
|
| Rate for Payer: Cash Price |
$990.52
|
| Rate for Payer: Cigna Commercial |
$1,644.27
|
| Rate for Payer: First Health Commercial |
$1,882.00
|
| Rate for Payer: Humana Commercial |
$1,683.89
|
| Rate for Payer: Humana KY Medicaid |
$681.28
|
| Rate for Payer: Kentucky WC Medicaid |
$688.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,624.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,462.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$694.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,743.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.13
|
| Rate for Payer: PHCS Commercial |
$1,901.81
|
| Rate for Payer: United Healthcare All Payer |
$1,743.32
|
|
|
MESH 3D MAX 4*6 LRG R
|
Facility
|
OP
|
$1,981.05
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.54 |
| Max. Negotiated Rate |
$1,901.81 |
| Rate for Payer: Aetna Commercial |
$1,525.41
|
| Rate for Payer: Anthem Medicaid |
$681.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,545.22
|
| Rate for Payer: Cash Price |
$990.52
|
| Rate for Payer: Cigna Commercial |
$1,644.27
|
| Rate for Payer: First Health Commercial |
$1,882.00
|
| Rate for Payer: Humana Commercial |
$1,683.89
|
| Rate for Payer: Humana KY Medicaid |
$681.28
|
| Rate for Payer: Kentucky WC Medicaid |
$688.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,624.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,462.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$694.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,743.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.13
|
| Rate for Payer: PHCS Commercial |
$1,901.81
|
| Rate for Payer: United Healthcare All Payer |
$1,743.32
|
|
|
MESH 3D MAX 4*6 LRG R
|
Facility
|
IP
|
$1,981.05
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.54 |
| Max. Negotiated Rate |
$1,901.81 |
| Rate for Payer: Aetna Commercial |
$1,525.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,545.22
|
| Rate for Payer: Cash Price |
$990.52
|
| Rate for Payer: Cigna Commercial |
$1,644.27
|
| Rate for Payer: First Health Commercial |
$1,882.00
|
| Rate for Payer: Humana Commercial |
$1,683.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,624.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,462.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,743.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.13
|
| Rate for Payer: PHCS Commercial |
$1,901.81
|
| Rate for Payer: United Healthcare All Payer |
$1,743.32
|
|
|
MESH 3D MAX 5*7 XLG L
|
Facility
|
OP
|
$2,163.05
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.20 |
| Max. Negotiated Rate |
$2,076.53 |
| Rate for Payer: Aetna Commercial |
$1,665.55
|
| Rate for Payer: Anthem Medicaid |
$743.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,687.18
|
| Rate for Payer: Cash Price |
$1,081.53
|
| Rate for Payer: Cigna Commercial |
$1,795.33
|
| Rate for Payer: First Health Commercial |
$2,054.90
|
| Rate for Payer: Humana Commercial |
$1,838.59
|
| Rate for Payer: Humana KY Medicaid |
$743.87
|
| Rate for Payer: Kentucky WC Medicaid |
$751.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,773.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,596.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$758.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,903.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,622.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$670.55
|
| Rate for Payer: PHCS Commercial |
$2,076.53
|
| Rate for Payer: United Healthcare All Payer |
$1,903.48
|
|
